What Women Must Know Before
NATIONAL JOURNAL OF HOMOEOPATHY 1994 Nov / Dec Vol III No 6.
Leslie Laurence.
Menopause
Sharon Runnels thought there was something horribly wrong. In 1992, at the age of 39. she went for three months without menstruating. Then her period returned, but her cycles became irregular, varying from 21 days to almost two months. Later she developed night sweats - mild at first, but within a year, so intense was the sweat that she couldnt sleep throughout the night. "Id wake up and the sheets would be damp," Says Runnels, a dietician who lives with her husband and their 12-year-old son. "Id throw the covers off and then Id freeze."
Runnels also noticed other changes. Her concentration became so short she couldnt comprehend the articles she normally breezed through in professional journals. She began having mood swings. The smallest incident the day her son left his homework assignment at school, for instance - was enough to send her into a rage. "Ive always been in control of my emotions," says Runnels. "This was like being on a roller coaster. I felt alienated, like whose body is this?"
After consulting her doctor, Runnels learned she had begun Peri-menopause - the stage of life that commences when a womans body start showing signs of approaching menopause. "It caught me off guard," Runnels says, "I didnt realize perimenopause existed".
until recently, this phase of a womans life didnt get much attention. But with new ways of measuring hormone levels, "we are realizing that menopause doesnt just happen one day," says Dr. Penny Wise Budoff, Director Emeritus of a womans health service. "Its a process that goes on for some time."
Experts say Perimenopause can begin as early as three to eight years before as early as three to eight years before a womans final menstrual period. Although one study cited the average age for the beginning of Perimenopause as 47, it can hit a woman as young as in their late 30s. The hormonal changes that occur may lead to irregular menstrual periods and symptoms such as hot flushes, breast tenderness, vaginal dryness, insomnia, mood swings and irritability.
"Its not unlike a bad case of premenstrual syndrome," says Dr. Gloria Bachmann, a professor and chief of Obstetrics and Gynecology at a medical college. Some of the worst symptoms of the menopausal transition occur in the earliest stages, according to Gail Sheehy, author of The Silent Passage. Compounding the physical symptoms is the fact that ;many women have no idea theyve begun perimenopause. "They feel - and in fact are - out of control of their bodies. says Sheehy.
Katherine Pavlik knows that feeling. When she was 43, she began to have sleep disturbances and bouts of sadness. Three different specialists couldnt give her any clear answers. "Perimenopause is an area of research that is totally infant," says Lonnie Barbach in The Pause: Positive Approaches to Menopause. "There is so little known."
Hormonal Imbalances: Fortunately, that may be changing. A womans health study followed 2500 middle-aged women over a four-year period. And Americas National Institute on Ageing has begun a study that will track 2000 woman through menopause. Such attention is welcome because "women want to know whats happening to their bodies, says Dr. Bachmann. "When they realize whats going on, they gain comfort."
What we do know is that - cells surrounding the eggs stored in womans ovaries are the major producers of the hormones estrogen and progesterone. Peri-menopause starts when the ovaries begin to shut down - a natural result of advancing years. Eggs, and the high levels of hormones accompanying them are no longer released every month.
One result of this is erratic bleeding. Some Peri-menopause women experience longer periods and heavier flow; others find the cycles are shorter and bleeding is scant. Many women will occasionally miss one or more period completely.
Doctors have traditional believed that oestrogen deprivation was the major cause of erratic bleeding. But new research suggests declining progesterone levels may also play a role. "Women have fewer ovulatory cycles, so progesterone frequently isnt secreted at the levels it would be in the normal menstrual cycle," says Dr. Peter Schmidt, chief of reproductive endocrine studies at a leading mental health institute.
While menstrual cycle changes are a normal part of the perimenopausal transition, they can sometimes precipitate or signal the essence of a medical disorder. If bleeding becomes heavy and wont stop, for instance, a woman can become anemic. Or a heavier than usual flow with periods closer together can also be the result of more serious problems, such as polyps, fibroids, tumors or cancer.
Thats why it is important for a woman experiencing erratic periods or any unexplained vaginal bleeding - to discuss the problem with her Physician or Gynecologist. Ultrasound can rule out tumors or other abnormalities, as can biopsy. Blood tests can measure hormone levels to help determine whether a woman has indeed begun perimenopause.
While erratic menstrual periods are often the most easily pinpointed symptom of Perimenopause, they are rarely bothersome. the hormone flux of this phase often leads to a symptom traditionally associated with menopause - hot flushes.
Researchers arent sure what causes these feelings of intense heat, but they suspect it is related to oestrogen decline. "During perimenopause, hot flush episodes are most likely to occur just before a womans period or during missed cycles" says Dr. James Simon, chief of reproductive endocrinology and infertility at a Washington medical college.
One sufferer described the feeling as "a sudden rush of heat 4in your chest radiating out. The top of your head feels like someone turned on a burner." For some woman, flushes are accompanied by anxiety, depression or sensation of tingling, throbbing and light-headedness. Others complain they are disoriented and unable to concentrate.
One of the best ways to ease the transition through Perimenopause is to be prepared for it. "Knowledge is power," says Dr. Sheldon Cherry, co-author of The Menopause Book: A Guide to Health and well-being for woman After Forty. "The more you know what might happen, the less you will fear it."
For some women, however, symptoms are severe enough to warrant medical intervention. Low dose oral contraceptives may provide relief. Janet Helfand started taking low-dose pills at the age of 41 and the irregular bleeding, bloating and hot flushes vanished. "My head became clearer and that unwell feeling went away," she says.
Another option is hormone replacement therapy (HRT), which provides oestrogen and progesterone to supplement the cessation of the bodys own production. "It definitely made me feel better," says Robin Berkley, 40, of California. However, your doctor should be informed if there is a family history of breast cancer, in which case he may decide against hormones.
Researchers are exploring other, more natural remedies to ease woman through perimenopause. Some doctors say that vitamin E and soyabean products appear to alleviate hot flushes for many women. Non-prescription replenishing gels - imported, hence not available at all chemists - can help restore moisture to vaginal tissues. Exercise may also play a role. In a review of current research, John Shaver, co-director of a womans health center, found one study suggesting that hot flushes were half as common in those who were sedentary.
While there is no uniform agreement on the best way to deal with perimenopause, health care professionals stress its important for women to visit their doctor routinely. And smokers should try quitting now. In addition to increasing numerous health risks, smoking accelerates the onset of menopause by as much as two years.
"The relevant issue for women as they go into menopause is prevention," says Dr. Bachmann. "It is not so much what you do by the time youre menopausal, but what you do to prepare for it that makes a difference."
